Bone marrow aspiration.
Explore the source record for details and available documents.
Biopsy, Needle↗
Biomedical subjects
W B Rodgers
Publications and source records attributed to W B Rodgers.
Massive subperiosteal hemorrhage and femoral shaft osteonecrosis: a complication of tissue plasminogen activator therapy for purpura fulminans.
We present the case of a child who developed a massive subperiosteal hemorrhage and subsequent osteonecrosis of her right femur after treatment with tissue plasminogen activator for post-varicella streptococcal purpura fulminans. Radiographs showed posteromedial translation of the capital femoral epiphysis on the necrotic shaft, and the hip was immobilized. The femur slowly remodeled and has continued to grow. The child is independently ambulatory with a 2.1-cm leg length discrepancy, a varus deformity of the hip, and a valgus distal femur.
Bone Remodeling↗
Spinal fusion in patients with congenital heart disease. Predictors of outcome.
The strong association between congenital heart disease and spinal deformity is well established, but data on the risks and outcome of spinal fusion surgery in patients with congenital heart disease are scarce. The purpose of this study was to identify predictors of perioperative risk and outcome in a large series of children and adolescents with congenital heart disease who underwent spinal fusion for scoliosis or kyphosis. In the authors' retrospective analysis of 74 consecutive patients with congenital heart disease undergoing spinal fusion, there were two deaths (2.7%) and 18 significant complications (24.3%) in the perioperative period. Preoperative cyanosis (arterial oxygen saturation < 90% at rest) with uncorrected or incompletely corrected congenital heart disease was associated with both deaths. Complications occurred in nine of 18 (50%) patients with cyanosis and in 11 of 56 (20%) patients without cyanosis. As judged by multivariate analysis the best predictors of perioperative outcome were the overall physical status of the patient as represented by the American Society of Anesthesiologists' preoperative score and a higher rate of intraoperative blood loss. Seventeen of 43 patients (40%) with an American Society of Anesthesiologists score of 3 or higher experienced complications including two perioperative deaths. Successful spinal fusion and correction were achieved in 97% of patients. Children and adolescents with congenital heart disease can undergo elective spinal fusion with risks that relate to overall cardiac status. Careful assessment of preoperative status by pediatric cardiologists and cardiac anesthesiologists familiar with surgical treatment of patients with congenital heart disease will assist the orthopaedic surgeon in providing the most realistic estimate of risk.
Adolescent↗
Occipitocervical fusions in children. Retrospective analysis and technical considerations.
This report presents a retrospective analysis of the authors' experience with occipitocervical fusions in children and adolescents during the last 2 decades. A description of an operative technique devised by the senior author (JEH), and a comparison of the results using this and other methods of fusion are given. Twenty-three patients underwent occipitocervical fusion. Fifteen of the patients were operated on using the authors' technique. To achieve stable fixation of the distal cervical vertebra a threaded Kirschner wire was passed transversely through the spinous process; occipital fixation was achieved by the traditional method of wiring corticocancellous bone graft to the skull through burr holes. The occipital wires then were wrapped around the Kirschner wire and the graft was cradled in the resulting nest. Halo immobilization was used in 10 patients for an average of 12.5 weeks (range, 6-24 weeks). Twenty-two patients achieved successful fusion at an average followup of 5.8 years (range, 1-14.33 years). Several complications, including transient quadriplegia in one patient, pseudarthrosis in two (one of which persists), hardware fixation failure in one, unintended distal extension of the fusion, pneumonia, wound infection, halo pin infection, skin breakdown under the halo vest, hydrocephalus, cerebrospinal fluid leak, and traumatic fusion fracture were encountered. Results using the technique described herein are comparable with or better than the results reported in the previous literature, and the results of the patients in this series in whom the technique was not used.
Adolescent↗
Spinal deformity in myelodysplasia. Correction with posterior pedicle screw instrumentation.
STUDY DESIGN: A retrospective review of transpedicular instrumentation used in a series of 24 patients with myelodysplastic spinal deformities and deficient posterior elements. OBJECTIVE: To describe the usefulness and efficacy of these instruments in the treatment of complicated myelodysplastic spinal deformity. METHODS: The mean preoperative scoliosis was 75.7 degrees (range, 39-130 degrees) in the 22 patients with scoliotic deformities; 4 patients with thoracic hyperkyphoses averaged 70.5 degrees (range, 46-90 degrees) and 10 patients with lumbar kyphoses averaged 80.5 degrees (range, 42-120 degrees). The instrumentation extended to the sacrum in 4 patients and the pelvis in 9; 10 patients also underwent anterior release and fusion and 7 underwent concomitant spinal cord detethering. At an average follow-up of 4.0 years (2.0-7.7 years; one patient died at 8 months), all patients have fused (with the exception of two lumbosacral pseudarthroses). RESULTS: At last follow-up, deformity measured 32.1 degrees scoliosis (range, 6-85 degrees), 30.8 degrees thoracic kyphosis (range, 24-35 degrees), and 0.0 degree lumbar kyphosis (range, 35 degrees kyphosis to 29 degrees lordosis). Three patients lost some neurologic function after surgery; two recovered within 6 months and one has incomplete recovery. No ambulatory patient lost the ability to walk. Five patients required additional surgical procedures; in three cases, there was instrumentation breakage associated with pseudarthrosis or unfused spinal segments. CONCLUSIONS: Pedicle screw instrumentation is uniquely suited to the deficient myelodysplastic spine. Compared with historical control subjects, these devices have proven capable of significant correction of both scoliotic and kyphotic deformities. This instrumentation appears particularly useful in preserving lumbar lordosis in all patients and may preserve more lumbar motion in ambulatory myelodysplasia patients.
Adolescent↗
Chondromyxoid fibroma of the ala of the sacrum presenting as a cause of lumbar pain in an adolescent.
We report a case of chondromyxoid fibroma of the ala of the sacrum: its presentation, diagnosis, treatment, and resolution. Although this tumor is admittedly rare, our case demonstrates the need for careful evaluation of pack pain in an adolescent.
Adolescent↗
Surgery of the spine in myelodysplasia. An overview.
Significant spinal deformity is particularly common in nonambulatory patients with myelodysplasia. Progressive deformity may be caused by congenital anomalies, paralytic collapse, hip contractures, or spinal cord tethering. Existing or projected functional impairment should be the principle indication for treatment. Surgical treatment is complicated by poor soft tissue coverage, associated contractures, lack of sensation, weak bone, and absence of posterior elements. Successful fusion can be achieved by circumferential (anterior and posterior) fusion and current rigid segmental instrumentation. The unique deformities and bony anatomy require individualized techniques to achieve fixation.
Arthrodesis↗
Parturition-induced pelvic dislocation: a report of four cases.
OBJECTIVE: To describe our experience with four cases of severe pelvic dislocation associated with difficult parturition. DESIGN: Retrospective case series. PATIENTS: Four patients, each with rupture of the symphysis pubis and sacroiliac joints during labor. All injuries were associated with significant initial pain and disability. All developed persistent symptoms related to the sacroiliac disruption. INTERVENTIONS: The three patients who had presented acutely were freated with closed reduction and application of a pelvic binder. Two underwent closed reduction of their pelvic dislocation while anesthetized with a general anesthetic. One patient (N.A.), who presented late, had not been treated with a binder. RESULTS: All four patients had persistent posterior pelvic (sacroiliac) pain. In two patients a postpartum neuropathy persisted. CONCLUSIONS: Severe pelvic dislocations are rare during labor, with conservative treatment reported to be successful in most cases. The persistence of symptoms in our patients emphasizes the need for careful examination and follow-up of these rare injuries. Because the outcome in our patients was poor and results in the literature are equivocal, we suggest the consideration of an operative approach to treatment in patients with symphyseal diastasis of > 4.0 cm.
Adult↗
Pyrexia after total knee replacement. A cause for concern?
Ninety patients who had undergone 92 total knee replacements were reviewed to determine predictors of postoperative pyrexia and to evaluate the relative value of septic screening in this group of patients. Postoperative pyrexia was defined as an axillary temperature greater than 37 degrees C (98.4 degrees F) on any or all of the 5 days after surgery. All of the patients in this series developed a postoperative pyrexia after knee arthroplasty. None of 16 patients (17% of arthroplasties) with a temperature of 39 degrees C (102 degrees F) or greater had evidence of infection. None of the 4 patients with urinary tract infections developed a pyrexia exceeding 38 degrees C (101 degrees F). At a minimum of 2 years' follow-up, none of the 90 patients had developed an infected arthroplasty. Logistic regression analysis showed that the risk of becoming significantly febrile (temperature > 39 degrees C) doubled for every unit drop in hematocrit and increased fourfold for each unit of blood transfused after surgery. Perioperative blood loss and pyrexia were correlated, but the correlation was not statistically significant. The duration of procedure, tourniquet time, and patient age or sex were not associated with risk of pyrexia. In this series, there was no association between a pyrexia greater than 37 degrees C, septic screening, and the presence of an infective focus. Early postoperative pyrexia after arthroplasty is a normal physiological response, and a significant pyrexia can be predicted by a drop in hematocrit and/or after postoperative transfusion. Pyrexia in the early postoperative period following total knee arthroplasty warrants detailed laboratory and radiographic investigation only in the presence of positive physical findings.
Aged↗
Protrusio acetabuli and bilateral basicervical femoral neck fractures in a patient with Marfan syndrome.
A 22-year-old man with Marfan syndrome and bilateral protrusio acetabuli presented with bilateral femoral neck stress fractures after vigorous stretching exercises for hip "stiffness." Fifteen years later, his fractures, which were treated with internal fixation, have healed, his acetabular protrusion has not worsened, and his perceived hip "stiffness" persists. This case demonstrates a rare manifestation of Marfan syndrome, protrusio acetabuli, and a possible side effect of vigorous stretching in the face of abnormal joint mechanics.
Acetabulum↗
Chronic Monteggia lesions in children. Complications and results of reconstruction.
We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.
Age Factors↗
Retrograde intramedullary nailing of the femur using a tibial nail--the adjunctive use of an existing implant: a case report.
A 74-year-old male involved in a pedestrian-automobile collision sustained a comminuted supracondylar-diaphyseal femur fracture. The fracture was stabilized by retrograde intramedullary fixation with a Synthes unreamed tibial nail. Knee motion reached 0 degree-120 degrees by the sixth postoperative day and the fracture healed within twelve weeks. Twelve months after his injury, his knee motion was symmetric to his uninjured side and he had resumed full preinjury activities, including martial arts training. Although antegrade intramedullary nailing remains the treatment of choice for fractures of the femur, this case highlights the usefulness of retrograde nailing and demonstrates the adjunctive application of an existing implant, the tibial nail, in certain special trauma situations.
Accidents, Traffic↗
The use of osseous suture anchors in the treatment of severe, complicated elbow dislocations.
Seventeen patients who sustained severe trauma resulting in dislocation or fracture-dislocation of the elbow were treated using osseous suture anchors to repair the soft-tissue constraints of the elbow. In 15 of these patients, the medial collateral ligament and flexor-pronator origin were repaired. Ten patients underwent repair of the lateral collateral ligament using anchors. Five patients were also treated with a hinged external fixator. All of the elbows were rendered grossly unstable by the injury; all of the patients had stable elbows at follow-up. Elbow flexion averaged 127 degrees; an average 19 degrees extension loss was noted. The arc of forearm rotation averaged 156 degrees. The aggressive approach detailed in this report is applicable only to severe injuries to the elbow, not routine dislocations. These cases demonstrate the reliability of the osseous suture anchor in the operative treatment of massive trauma to the elbow.
Adult↗
Metastatic malignant chondroblastoma.
A case of malignant chondroblastoma with metastases is reported. The patient initially presented with a lytic lesion in his left pubic ramus. He was treated with curettage, but the lesion recurred 3 years later. After repeated curettage, radiation therapy, and the late development of multiple bone and soft-tissue metastases, he succumbed to his disease 13 years after diagnosis. The surgical pathology from each of his several procedures was reviewed. Although no definite malignant transformation was apparent, a metastatic deposit curetted 3 months prior to death showed some increase in mitotic activity. Flow cytometry of specimens from the patient's first local recurrence and a late distant metastasis was performed and revealed the interval development of a minor aneuploid peak between the two samples. This fatal chondroblastoma is the only one in our series of 80 patients treated over the past 25 years.
Adult↗
Marginal mandibular nerve palsy due to compression by a cervical hard collar.
A case history of a trauma patient who developed a palsy of the marginal mandibular nerve from compression by a cervical spine hard collar is presented. After clinical and radiographic screening found no evidence of occult cervical spine pathology, the collar was removed; the palsy resolved uneventfully during the next 2 days.
Adult↗
Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system.
Eleven patients were prospectively treated with bilateral short-segment transpedicular instrumentation using the Posterior Segment Fixator (Ace Medical Co., Los Angeles, CA, U.S.A.) construct combined with posterolateral fusion using autogenous iliac crest bone graft for the treatment of thoracolumbar vertebral fractures. All patients were evaluated clinically, radiographically, and functionally for a minimum of 2 years (mean 33 months). Four of the 11 patients (36.3%) had breakage or disengagement of the caudad screws during this interval. During the follow-up period, the angle of kyphosis increased an average of 12.9 degrees. The loss of correction was greater in those patients in whom the instrumentation failed (22 degrees) than in those patients in whom it did not (7.7 degrees). Five of the patients (45.5%) had a progressive increase in the angle of kyphosis of 10 degrees or more. At follow-up, the average loss of anterior vertebral body height for all 11 patients was 14% when compared with the body height that had been attained at surgery. Six of these patients (54.5%) had 10% or more loss of anterior body height. Despite the high incidence of failure of the instrumentation, progressive increase in the angle of kyphosis, and progressive loss of anterior vertebral body height, there was no worsening in the patients' Frankel grade postoperatively. The high rate of hardware failure and major postoperative loss of fracture reduction associated with this construct suggest that posterior short-segment pedicle-screw instrumentation with the Posterior Segment Fixator was not adequate to ensure stabilization of thoracolumbar fractures in this small group of patients. Maintenance of postoperative fracture reduction was the most consistent predictor of satisfactory functional outcome.
Adolescent↗
Dislocation of the elbow complicated by arterial injury. Reconstructive strategy and functional outcome.
Four cases of arterial injury complicating posterior dislocation of the elbow are described. All of these patients were treated by emergent revascularization; reconstruction of the soft-tissue constraints of the elbow joint was performed by using osseous suture anchors. Despite prompt treatment of the vascular injury and successful restoration of elbow articulation and stability, all of the patients had residual functional disability. The previous literature has not discussed the functional results of these reconstructions. This report underscores the severity of these injuries, details our reconstructive strategy, and analyzes the functional outcome of these badly traumatized extremities.
Adult↗
Incidence of trigger digits in newborns.
Trigger digits are uncommon in infants. We prospectively examined 1046 newborns to determine the congenital incidence of this condition. No trigger digits were identified among these children. This correlates by power calculation to an incidence of 0-3 trigger digits per 1000 live births. We then retrospectively reviewed the records of all children who had undergone surgical release of trigger digits at our hospital from July 1989 to July 1992. Seventy-three children underwent 89 trigger thumb releases and 5 children had 11 trigger finger releases. Only seven of these children presented at less than 6 months of age and none presented at less than 3 months of age. This study raises the possibility that trigger digits may represent lesions acquired after birth.
Child, Preschool↗